Attachable tip for electromagnetic hand piece

ABSTRACT

A system for the surface and subsurface delivery of therapeutic and cosmetic agents. The system includes a disposable attachable tip that can be pre-filled with medications or cosmetics and attached to hand pieces including electromagnetic and mechanical energy hand piece devices.

RELATED APPLICATIONS

This application is a divisional of application Ser. No. 15/408,415filed Jan. 17, 2017 which claims priority to Provisional Application No.62/280,075 filed Jan. 18, 2016. The contents of these applications areincorporated herein in their entirety for all purposes.

FIELD OF THE INVENTION

The invention generally relates to attachable tips for use with handpieces of electromagnetic and mechanical energy delivery devices formedical and cosmetic use. More particularly, the invention relates toattachable tips for delivering therapeutic and cosmetic agents inconjunction with hand pieces of electromagnetic and mechanical energydelivery devices.

BACKGROUND OF THE INVENTION

A variety of different compounds, compositions, drugs, skin careproducts, and cosmetics are in use today. Moreover, these agents havebeen used following the application of laser therapy and mechanicalabrasion as a means for alleviating pain and preventing infection.However, the use of mechanical and electromagnetic energy has not beenapplied to effect the delivery of therapeutic and cosmetic agentssimultaneously with the application of mechanical and electromagneticenergy.

Thus, a need exists for devices and methods that permit the applicationof therapeutic and cosmetic agents simultaneously with the delivery ofmechanical and electromagnetic energy to the skin and its associatedstructures.

SUMMARY OF THE INVENTION

The present invention meets the needs in the art by providing attachabletips for hand pieces that generate electromagnetic and mechanic energyfor application to the surface of the skin. The attachable tips of theinvention can deliver a precise amount of drug, medication, biologic,gene, compound or a composition of several substances, coolant,cosmetics pre-loaded in it or supplied to it.

In one aspect, the invention provides a system comprising a laser handpiece and an attachable tip. The system includes components forproducing a continuous or pulse energy beam, components for deliveringsubstances to the damaged region of skin. The system can be designed tocontrol and utilize a laser beam for partial perforation or vaporizationof small volume of skin tissue and using a disposable or refillableattachable tip for a laser hand piece to deliver a substance which isapplied prior, simultaneously or with some delay to produce acombination of laser action with the action of an agent at the sametime. In some embodiments, a laser beam is delivered to produce on theskin damage using a scanning system or optical system to produceplurality of laser beams. The system can comprise a topical substancedelivery attachable tip having one or more applicators with one or moreagents delivered from individual applicators. The agent can be amedication, skin care, cosmetics, dye etc.

In one aspect, the invention provides a topical delivery attachable tipthat can be used with a skin electroporation system for deliveringtopical agents while the skin is damaged by electric energy.

In one aspect, the invention provides an attachable tip for a laser handpiece that is designed to deliver skin surface cooling. The surfacecooling can be provided by a heat absorbing agent. The heat absorbingagent can be a cooling gel delivered at a temperature of between about1° C. and room temperature (e.g. 25° C.).

In one aspect, a topical delivery attachable tip can be combined withany laser hand piece of existing medical, aesthetic and cosmetic lasers.

In one aspect, the invention provides a system comprising an attachabletip as disclosed herein, and a hand piece as disclosed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an embodiment of a laser hand piece and attachable tip.

FIG. 2 shows a block diagram of a battery operated laser hand piece.

FIG. 3 shows the design of an attachable tip.

FIG. 4A shows an embodiment of an attachable tip with multipleapplicators.

FIG. 4B shows a further embodiment of an attachable tip with multipleapplicators.

FIG. 4C shows a further embodiment of an attachable tip with multipleapplicators.

FIG. 5 shows a battery operated laser hand piece with an internalscanner and attachable tip.

FIG. 6 shows a laser hand piece being applied to a patient.

FIG. 7 is a graph showing absorption coefficients in blood.

FIG. 8 is a graph showing absorption coefficients in skin.

FIG. 9 is a diagram of laser-tissue interactions.

FIG. 10 shows an embodiment of an attachable tip for a laser hand piece.

FIG. 11 shows lenses for use with an attachable tip for focusing ordefocusing a laser beam.

FIG. 12A shows an attachable tip for use with an ultrasound hand piece.

FIG. 12B shows a further embodiment of an attachable tip for use with anultrasound hand piece.

FIG. 13 shows an attachable in conjunction with a fractional laser handpiece.

FIG. 14 shows an attachable tip with a fiber optic laser hand piece.

FIG. 15 shows an attachable tip with a magnetic piston.

FIG. 16 shows a refillable attachable tip for a laser hand piece.

FIG. 17 shows a refillable attachable tip attached to a laser handpiece.

FIG. 18 shows an attachable tip for an ultrasound hand piece.

FIG. 19 shows an attachable tip for a hand piece with an ultrasonictransducer and internal diode lasers.

FIG. 20 shows an attachable tip for a hand piece with an internalultrasonic transducer and external diode lasers.

FIG. 21 shows a retractable attachable tip for an ultrasound hand piece.

FIG. 22A shows a multi-chamber attachable tip.

FIG. 22B shows a perspective view of the attachable tip of FIG. 22A.

FIG. 23 shows a multi-chamber attachable tip.

FIG. 23A shows a cross-sectional view of the multi-chamber attachabletip of FIG. 23.

FIG. 24 shows an attachable tip for combining liquid and solidcomponents.

FIG. 25 shows an attachable tip configured to heat components within thechamber of the attachable tip.

FIG. 26A shows a multi-chamber attachable tip with air and water coolingfeatures.

FIG. 26B shows a cross-sectional view of the multi-chamber attachabletip of FIG. 26A.

DETAILED DESCRIPTION

The invention generally relates to attachable tips for use with handpieces that deliver electromagnetic or mechanical energy to the skin.More particularly, the invention relates to attachable tips fordelivering therapeutic and cosmetic agents to the skin in conjunctionwith hand pieces that apply electromagnetic and mechanical energy to theskin.

As used herein, the term “hand piece” refers to a device that is capableof delivering mechanical and/or electromagnetic energy to the skin of asubject. Hand pieces include, but are not limited to, devices capable ofdelivering one or more of: laser energy; intensive pulse light (IPL)energy; ultrasound energy; radio frequency (RF) energy; microwaveenergy; light emitting diode energy; x-rays; ionizing radiation; andelectron beams.

Hand pieces for use with the invention can be stand-alone devices thatare not connected to any remote energy source and/or central control orprocessing unit. A non-limiting example of a stand-alone device is alaser hand piece, such as the device depicted in FIG. 1. Hand pieces canbe powered by a battery or can plug in to a remote power source.

As used herein, the term “agent” refers to one or more substances thatproduce a desired biological, pharmacological, physiological and/orcosmetic effect in the subject to which the substance is administered.

FIGS. 1 through 5 show features of some embodiments of the presentinvention. The embodiment shown in FIG. 1 includes laser hand piece 12,attachable tip 16 and laser beam 19 emitting from hand piece 12 onto thesurface of the skin 8. Attachable tip 16 can function as a standoff foroptimal focusing of laser beam 19 onto the surface of the skin.Attachable tip 16 can contain one or more chambers as disclosed hereinfor containing an agent thereby permitting attachable tip 16 to functionas an applicator that permits an agent to be applied to the skinsimultaneously with the application of a laser beam. Attachable tips foruse with the embodiments depicted in FIGS. 1 and 5 can assume theconfigurations depicted in FIGS. 4A-4C. The hand piece can be batteryoperated. The hand piece can have the functionality depicted in FIG. 2.

FIG. 6 shows an embodiment of the inventive device having laser handpiece 12 and flexible supply tube 2. Flexible supply tube 2 can comprisefiber bundle 57 containing fibers and cooling air tube 51.

FIG. 2 shows the block diagram of an embodiment of a laser hand piececomprising a light energy emitting module 9, beam shaping lenses 24,control circuit 26, re-chargeable battery 6, sensors 11 and controlpanel 56 having a display. The light source can be a laser diode. Thewavelength of the laser diode can be in the range of 1930 nm. The laserwavelength can be one or more of those depicted in FIGS. 7 and 8. Thelaser output can be laser pulses. The energy of the pulses and theirrepetition rate can be set at control panel 56 and displayed at thescreen. The pulses can be one or more of those depicted in FIG. 9. Thelaser beam can be focused by beam shaping lenses 24 in a small spot at adistance of a length of that corresponds to the standoff of theattachable tip. Unless provided otherwise by the context of theirdescription and/or function, the hand pieces disclosed in thisspecification which incorporate a laser can have the functionalitydescribed in FIG. 2. as well as the wavelengths and pulse intensitydisclosed in FIGS. 7-9.

FIG. 3 shows an embodiment of an attachable tip according to theinvention. Attachable tip 16 is defined by housing 38. Housing 38 can bemade of a medical grade plastic. Attachable tip 16 can be enclosed in asterilized individual bag. Attachable tip 16 can have attachment surface36 for interacting with a hand piece for attaching attachable tip 16 tothe hand piece. Attachable tip 16 can have chamber 25. Chamber 25 can bepre-filled filled with one or more agents. Chamber 25 can have one ormore agents introduced into it by injection by syringe 34 having aneedle for piercing housing 38. Chamber 25 can be under vacuum so as todraw the agent(s) from syringe 34 into chamber 25. Syringe 34 can beused to load one or more agents into an empty chamber 25 or used tointroduce an additional one or more agents into chamber 25 which ispre-loaded with one or more agents. The one or more agents loaded orprefilled into chamber 25 can be a liquid, gel, cream, solid or otherform of medicated substance. Housing 38 can have port 33 for injectionof one or more agents into chamber 25. Port 33 traverses the outer andinner walls of housing 38 to permit the injection of one or more agentsinto chamber 25. Such ports may be advantageous when housing 38 isconstructed of a durable plastic incapable of being pierced by a needle.Attachable tip 16 can have application port 37 on the bottom surfacethat is coplanar with attachment surface 36. Attachable tip 16 can havean application port (not shown) on the lower surface that is adjacentto, and coplanar with laser beam 19. The application port(s) traversehousing 38 and place chamber 25 in fluid communication with the surfaceof the skin when the attachable tip is placed in contact with a subjectto be treated. Attachable tip 16 can have cap 32 for covering theapplication ports and preventing the escape of agents from a loadedchamber 25. Before use, cap 32 on the bottom of attachable tip 16 isremoved before or after attachable tip 16 is snapped to a hand piece.Attachable tip 16 can have roller ball applicator 21 for rolling one ormore agents onto the surface of the skin of a subject. In practice,attachable tip 16 is snapped onto a hand piece by interaction betweenthe hand piece and attachment surface 36. Chamber 25 can be prefilledwith an agent and/or have one or more agents introduced to it byinjection by syringe 34. Cap 32 is then removed from attachable tip 16and attachable tip 16 is contacted with the skin of a subject. One ormore agents are then permitted to escape the application port(s). In analternative embodiment, the one or more agents escape from applicationport 37 and are distributed onto the surface of the skin of a subject byroller ball applicator 21. The one or more agents can be applied to theskin before, during and/or simultaneously with the application of laserbeam 19. The fluid in the attachable tip could be slightly heated upwith electrical heater or by energy split from laser light. Applicationof the agent can take place after laser beam 19 damages the skin. Laserbeam 19 can be a wavelength of 1930 nm. Laser beam 19 can be laserpulses. Laser beam 19 can make small openings in the stratum corneum topermit one or more agents from chamber 25 to penetrate the skin. Theagent can be a filler such as, for example, hyaluronic acid. The fillercan occupy openings in the skin created by laser beam 19.

FIGS. 10 and 11 illustrate an embodiment of an attachable tip for usewith the invention. Attachable tip 16 has chamber 25 containing one ormore agents 20. Attachable tip 16 can be connected to laser hand piece12 by interaction of threads 10 with threads on hand piece 12.Attachable tip 16 has lens housing 13 having therein a plurality ofwindows 28 for transmission of laser beam 19 from laser hand piece 12.Each of windows 28 can contain focusing lens 22 or defocusing lenses 23.Focusing lens 22 focuses laser beam 19 onto a focal point as in focusedlaser beam 14. Defocusing lens 23 defocuses laser beam 19 into a diffuselaser pattern as in defocused laser beam 15. In operation, focused laserbeam 14 and/or defocused laser beam 15 is projected onto the skin of asubject from windows 28. Laser beam 19 can remain collimated as well.Chamber 25 can be a cylinder that is defined by an inner wall. Chamber25 can terminate in applicator surface 50 having therein a deliverywindow that traverses applicator surface 50 to permit chamber 25 to bein fluid communication with the skin of subject when attachable tip 16is placed in contact with the skin of the subject. Applicator surface 50can contain roller ball 21 for rolling agent 20 onto the skin of asubject. Chamber 25 can have a length that permits it to form a standofffor optimal focusing of laser beam 19 onto the surface of the skin of asubject. The length of chamber 25 can be coordinated with focusing lens22 and/or defocusing lens 23 to achieve a desired degree of focus and/ordefocusing of laser beam 19 on the skin of a subject. Laser beam 19 canbe an Er:YAG solid state laser with a wavelength of 2,930 nm. The one ormore agents can comprise an antracycline antibiotic.

FIGS. 12A and 12B show embodiments of an attachable tip for use with anultrasound hand piece. Attachable tip 16 includes chamber 25 forcontaining agent 20. Attachable tip 16 has a circular cross-section (notshown) such that attachable tip 16 and chamber 25 encircles transducer 7of hand piece 12. Attachable tip 16 is attached to hand piece 12 andtransducer 7 by sliding onto transducer 7 as attachable tip 16 andchamber 25 form a cylindrical annulus. Attachable tip 16 has one or morewindows 28 for placing chamber 25 in fluid communication with skin 8.Windows 28 traverse the wall of chamber 25. Windows 28 can be cappedwith a removable seal 55 to prevent agent 20 from escaping chamber 25.Windows 28 can have therein roller ball 21 for rolling agent 20 ontoskin 8. Agent 20 can be selected from the group consisting of: a coolinggel; lubricant; ultrasound imaging agent; and a combination thereof.Attachable tip 16 can be formed from a flexible, squeezable material topermit attachable tip 16 to be squeezed so that agent 20 is forcedthrough windows 28 and onto skin 8. In the embodiment depicted in FIG.12B, application of ultrasound energy (shock waves) from transducer 7functions to force agent 20 from chamber 25 onto skin 8.

FIG. 13 shows an embodiment of an attachable tip in conjunction with alaser hand piece emitting a fractional laser beam. Fractional lasers arepopular in dermatological and aesthetic fields. Some fractional lasersystems contain hand piece attachable tips but fail to provide anytherapeutic or cosmetic substances with it. The present inventiondemonstrates that a fractional laser hand piece can contain anattachable tip pre-filled with a medication, cosmetics or othersubstances that can be delivered during the lasering process. Attachabletip 16 has chamber 25 pre-filled with agent 20. Chamber 25 has at itslower end one or more windows 28 for placing chamber 25 in fluidcommunication with skin 8. Windows 28 traverse the inner and outer wallof chamber 25. Windows 28 can be in communication with one or moreroller ball applicators 21 for rolling agent 20 onto skin 8. Windows 28,and the upper end of attachable tip 16, can be enclosed by removableseal 55. Before attaching attachable tip 16 to a laser hand piece, upperremovable seal 55 has to be removed. In an alternative embodiment, seal55 on the upper end of attachable tip 16 remains in place whenattachable tip 16 is connected to a hand piece. In yet anotherembodiment, the upper end of attachable tip 16 is enclosed by a solidstructure (e.g. upper wall). Removable seal 55 will be removed from thelower end of attachable tip 16 before the lasering process to permitagent 20 to flow from chamber 25 onto skin 8. Laser beam 19 can have awavelength of around 1930 nm. Laser beam 19 can have a pulse energyaround 5-20 mJ. Laser beam 19 can be a fractional CO₂ laser with a 10micron wavelength and a pulse energy of 6-40 mJ. Laser beam 19 can be anEr:YSGG/Er:glass laser beam with a pulse energy of 2-35 mJ. Laser beam19 can have a wavelength corresponding to a laser beam spot to producean opening in the stratum corneum 8-1.

FIG. 14 shows an embodiment of an attachable tip in conjunction withlaser hand piece 12. Attachable tip 16 has chamber 25 which containsagent 20. Located at the bottom of attachable tip 16 are one or morewindows 28 for placing chamber 25 in fluid communication with thesurface of skin 8. Attachable tip 16 is traversed lengthwise by hollowcolumn 18 which is configured to permit laser beam 19 to traverse thenlength of attachable tip 16 unobstructed and contact skin 8. Hand piece12 can produce laser beam 19, or laser beam 19 can be produced from aremote unit and transmitted to hand piece 12 through fiber opticconduction through connection 27. Alternatively, hand piece 12 canproduce laser beam 19 and connection 27 can serve as a connection to aremote power source. Laser beam 19 can be a radio frequency (RF) laserbeam or an intense pulsed light (IPL) laser beam. A pressure in chamber25 can be maintained or produced by a squeezable bulb (not shown) ofhigher than an atmospheric pressure such that agent 19 will be forcedout of attachable tip 16 through windows 28 during the laser deliveringprocedure. Laser beam 19 can be a diode laser with a wavelength in therange of 1,930 nm and pulse energy in the range of 3-40 mJ. The agentcan be a myorelaxant compound. The agent can be botulinum toxin or aderivate of botulinum toxin.

FIG. 15 shows an embodiment of an attachable tip for use with a laserhand piece. Attachable tip 16 contains upper magnet 29 and lower magnet30 which face one another with the same polarity so that magnetic forcescreate a pressure so that lower magnet 30 is forced towards the bottomof attachable tip 16 thereby placing agent 20 under pressure withinchamber 25. Upper magnet 29 is attached to the wall of the attachabletip 16 and is used to attach attachable tip 16 to a hand piece bymagnetic force. Lower magnet 30 is movable within attachable tip 16 andforms a seal with the inner walls of attachable tip 16 so that agent 20can be contained within chamber 25 under pressure. Lower magnet 30 ispushed by magnetic forces from upper magnet 29 in the direction ofattachable tip windows 28 thereby squeezing agent 20 out through windows28 onto a laser treated surface (e.g. the skin of a subject). Attachabletip 16 contains hollow column 18 which permits laser beam 19 to traversethe length of attachable tip 16 unobstructed. Windows 28 can be sealedby a removable seal to prevent agent 20 from escaping until the releaseof agent 20 onto the surface of the skin is desired. Laser beam 19 canbe a 1,930 nm laser beam. Agent 20 can be selected one or more agentsselected from the group consisting of: a vaccine; antibody; long termrelease liposome; chemotherapeutic drug; and a combination thereof.

FIGS. 16 and 17 show an embodiment for an attachable tip that permitsthe refilling of agents during operation of a laser hand piece.Attachable tip 16 has chamber 25 for containing one or more agents 20.Attachable tip 16 has connector 17 which traverses the wall ofattachable tip 16 and places chamber 25 in fluid communication with asuitable agent loading device. Agents can be loaded into chamber 25through connector 17 via hollow conduit 5. Conduit 5 can be a tube orpipe of suitable material, such as, for example, vinyl, plastic, orpolyethylene. Attachable tip 16 has hollow column 18 which traverses thelength of attachable tip 16 and forms a path through which laser beam 19can traverse the length of attachable tip 16 unobstructed. Laser beam 19can be from a diode laser at 1,930 nm. Attachable tip 16 has one or morewindows (not pictured) on its lower surface to permit agent 20 to flowfrom chamber 25 onto the surface of the skin of subject. These windowscan be in fluid communication with one or more roller balls 21 forrolling agent 20 onto the skin of a subject. In practice, chamber 25 canbe pre-loaded with agent 20, loaded through connector 17, or acombination thereof. Chamber 25 can be filled with agent 20 while laserbeam 19 is applied to skin 8. Conduit 5 can be attached to a container(e.g. drug container, vial, IV bag, or syringe). Chamber 25 can beloaded before or during the application of laser beam 19. One skilled inthe art will recognize that loading chamber 25 through connector 17 canprovide a number of benefits. First, chamber 25 can be replenished withagent 20 should agent 20 be depleted during the lasering process.Second, other agents can be combined with agents already present inchamber 25. Third, a solid (e.g. lyophilized, preserved agent) can becontained within chamber 25, and then solubilized through theintroduction of a suitable liquid when the application of agent 20 isdesired. This permits agent 20 to remain preserved until the moment ofapplication. Fourth, agents can be provided sequentially, or in series,such as an anesthetic to reduce pain during lasering, followed byfilling and/or skin rejuvenating agents, then an antibiotic to preventinfection of the treated area.

FIGS. 18 and 21 show an embodiment of an attachable tip for use with anultrasound hand piece. Attachable tip 16 has a chamber 25 containingagent 20. The upper end of attachable tip 16 has threads which interactwith threads 10 on hand piece 12 to connect attachable tip 16 to handpiece 12. Attachable tip 16 has one or more windows 28 for permittingagent 20 to escape from chamber 25 onto the surface of skin 8. Handpiece 12 has transducer 7 for producing ultrasound energy for conductingimaging on a subject. In practice, threads 10 can be engaged with thethreads on hand piece 12 to advance hand piece 12 towards attachable tip16. Advancing hand piece 12 towards attachable tip 16 can be used todecrease the volume of chamber 25 thereby creating pressure and forcingagent 20 out of chamber 25 through windows 28 onto the surface of skin8.

FIG. 19 shows an attachable tip having both laser and ultrasoundfunctions. Attachable tip 16 comprises transducer 7 and one or morelaser diodes 4 for emitting one or more laser beams 19. Attachable tip16 comprises chamber 25 for containing one or more agents 20. Attachabletip 16 terminates in one or more windows 28 for permitting agent(s) 20to escape chamber 25 and contact skin 8. Attachable tip 16 has acircular cross section (not shown) such that chamber 25 forms an annularconfiguration that forms circular central column 18. Circular centralcolumn 18 permits laser beams 19 to traverse the length of attachable 16unobstructed to contact skin 8. Laser beams 19 can be of the same ordifferent wavelengths. Laser beams 19 can be of a wavelength sufficientto create holes 48 of a different depth and diameter in the skin'sstratum corneum 8-1, and reticular dermis 8-3 thereby permittingagent(s) 20 to penetrate these structures in skin 8. Agent(s) 20 can beselected from the group consisting of: insulin; one or more insulinderivatives; and a combination thereof. In an alternative embodiment,transducer 7 and one or more laser diodes 4 form a portion of a handpiece that is separate from, and attachable to, attachable tip 16.

FIGS. 22 and 23 show attachable tips having multiple chambers forcontaining one or more agents separately. The attachable tips shown inFIGS. 22 and 23 can be used to store one or more agents separately, thencombining them just before or simultaneously with the application oflaser and/or ultrasound energy to the skin of a subject.

FIG. 22 shows an attachable tip having a pair of chambers D1 and D2.Chamber D1 is separated from chamber D2 by wall 35 on opposing sides ofattachable tip 16. Wall 35 is interrupted by central column 18 whichoccupies the length of attachable tip 16 and forms a void through whichone or more laser beams 19 from hand piece 12 can traverse the length ofattachable tip 16 unobstructed to contact skin 8. Chamber D1 is depictedas containing a first one or more agents 20-1 and chamber D2 is depictedas containing a second one or more agents 20-2. Each of chambers D1 andD2 terminate in one or more windows 28 through which one or more agents20-1 and 20-2 are permitted to escape the chambers to contact skin 8.When one or more agents 20-1 and 20-2 escape chambers D1 and D2, theycombine to form composition 20-A on the surface of skin 8. Laser beam(s)19 can be of a wavelength sufficient to create one or more holes 48 inskin 8 to permit agents 20-1, 20-2, and/or composition 20-A to penetrateskin 8. In an alternative embodiment, hand piece 12 has an ultrasoundfunction that is provided by transducer 7 which forms an annular ringaround the end of hand piece 12.

FIG. 23 shows an embodiment of an attachable tip having multiplechambers for containing one or more agents separately. This particularembodiment permits premixing of agents within the attachable tip priorto, or simultaneously with, the application of laser and/or ultrasoundenergy from an attached hand piece. Attachable tip 16 has chambers 36-1,36-2 and 36-3 which form a number of concentric hemispheres along thelength of attachable tip 16. Opposite chambers 36-1, 36-2 and 36-3 are apair of chambers 36-4 and 36-5 which similarly form concentrichemispheres along the length of attachable tip 16. Chambers 36-1, 36-2and 36-3 are separated from chambers 36-4 and 36-5 by wall 35. Wall 35is interrupted by central column 18 which occupies the length ofattachable tip 16 and forms a void to permit one or more laser beams 19,from an attached hand piece, to traverse the length of attachable tip 16unobstructed so as to contact skin 8. One or more agents 20-1, 20-2,20-3, 20-4, and 20-5 are contained individually in chambers 36-1, 36-2,36-3, 36-4, and 36-5. A pair of mixing chambers 38-1 and 38-2 areprovided at the lower portion of each set of concentric hemisphericchambers. Mixing chamber 38-1 forms a void that connects each ofchambers 36-1, 36-2, and 36-3 through one or more windows (not shown).Agents 20-1, 20-2, and 20-3, combine in mixing chamber 38-1 to formcomposition 37-1. Mixing chamber 38-2 forms a void that connectschambers 36-4 and 36-5 through one or more windows (not shown). Agents20-4 and 20-5 combine in mixing chamber 38-2 to form composition 37-2.Before or during the application of laser and/or ultrasound energy, thewindows in mixing chambers 38-1 and 38-2 can be opened to permit theagents in the respectively connected chambers to combine. Alternatively,the windows in mixing chambers 38-1 and 38-2 are configured as openports which permit the free mixing of agents without the need foropening the windows. Mixing chambers 38-1 and 38-2 each contain one ormore windows 28 for permitting compositions 37-1 and 37-2 to escape andflow onto the surface of skin 8. Application of one or more laser beams19 onto skin 8 can create one or more openings in skin 8 therebypermitting compositions 37-1 and 37-2 to permeate skin 8. Mixingchambers 38-1 and 38-2 can be used for combining hydrophobic componentswith water solutions, or to mix biologics with drugs like cytokines,stem cells, cell factors, HLA, PRP, or to mix hair coloring componentsafter the laser bleaching of hairs, etc.

FIG. 24 shows an embodiment of an attachable tip having a chamber thatis divided into a sub-chamber by a valve. Opening of the valve permitsagents to be mixed prior to the application of laser and/or ultrasoundenergy from an attached hand piece. As shown in FIG. 24, attachable tip16 is connected to hand piece 12 by interaction of threads. Chambers ofattachable tip 16 in this embodiment are separated into two or moresub-chambers by valve 39. Valve 39 separates a lower portion of thechamber that is pre-filled with a solid state agent 53 from the upperpart of the chamber that is pre-filled with fluid 3. When switch 40opens valve 39, fluid 3 goes down through solid state agent 53 in thelower chamber thereby providing mixture 20-A for the delivery to thesurface or cavity of the skin 8 through one or more windows 28.Attachable tip 16 can have an annular cross-section with column 18forming a cylindrical void running the length of attachable tip 16 andforming a void through which one or more laser beams 19 can passunobstructed onto the surface of skin 8. Laser beam(s) 19 can be of awavelength, intensity and duration suitable for creating one or moreopenings in skin 8 to permit mixture 20-A to permeate skin 8. Laserbeam(s) 19 can be from a diode laser with wavelength of 1,930 nm andpulse energy 6-12 mJ. Solid state agent 53 can be, for example alyophilized, or otherwise preserved, drug or biologic. Solid state agent53 can be a lyophilized vaccine, monoclonal antibody and/or fragmentthereof. Solid state agent 53 can be Bevacizunab, Ramibizutab,Transtuzumab, TherCIM, Cetuximab, Infliximab, a cytokine, or stem cellfactor. Fluid 3 can be lactated, water, Ringers solution, or sodiumchloride (e.g. 0.9% solution.)

FIG. 25 shows an embodiment for an attachable tip with state-changingfunctionality. Attachable tip 16 forms a chamber in the shape of adouble walled cylindrical annulus. The chamber is filled with solidstate agent 53 and light electromagnetic energy absorbing particles 54.Particles 54 can be of micro or nanosize. When a laser hand piece isconnected to attachable tip 16 and in operation to deliver one or morebeams 19 to skin 8, it simultaneously passes through central column 18and the chamber. Solid state agent 53 scatters energy in the chamberwhich is absorbed by particles 54 thereby raising the temperature in thechamber and transferring heat to surrounding solid state agent 53. Thisincrease in heat causes a melting and transition of solid state agent 53into liquid state 49. Liquid state 49 is permitted to escape from thechamber through one or more windows 28 and onto skin 8. Laser beam(s) 19can be of a wavelength, duration and intensity sufficient to createopenings in skin 8 thereby permitting liquid state 49 to permeate skin8.

FIG. 26 shows an embodiment of an attachable tip having cooling, mixingand aerosol-forming functions. Attachable tip 16 has a plurality ofchambers 20-6 for containing one or more agents. Chambers 36-1 and 44contain cooled fluid that is received from conduits 46. Chambers 36-2contain cooled gas that is received from gas conduits 45. Chambers 20-6and 44 are in fluid communication with mixing chamber 37-2 through oneor more windows (not shown) to permit one or more agents from chamber20-6 to combine with cooled fluid from chamber 44 to form composition20-A. Composition 20-A is permitted to exit mixing chamber 37-2 throughone or more windows 28. Chambers 36-1 and 36-2 are in fluidcommunication with mixing chamber 37-1 through one or more windows (notshown) to permit cooled gas from chamber 36-2 to combine with cooledfluid from chamber 36-1 to form aerosol 47. Aerosol 47 is permitted toescape mixing chamber 37-1 through one or more windows 28. Attachabletip 16 has within its center hollow column 18 for permitting one or morelaser beams 19 to pass unobstructed from a hand piece through the lengthof attachable tip 16 and onto skin 8. In operation, a cooled fluid isdelivered into chambers 44 and 36-1 by conduits 46. Cooled air issimultaneously delivered to chambers 36-2 by conduits 45. Theintroduction of the cooled fluid to chamber 44 results in the formationof a composition 20-A as one or more agents from chamber 20-6 combinecooled fluid from chamber 44 in mixing chamber 37-2. The introduction ofthe cooled fluid to chamber 36-1 and cooled gas to chamber 36-2 resultsin the formation of aerosol 47 as the cooled fluid and cooled gascombine in mixing chamber 37-1. Composition 20-A and aerosol 47 exitwindows 28 and contact skin 8 as one or more laser beams 19 are appliedto skin 8. Thus, attachable tip 16 provides for the simultaneousapplication of a cooled therapeutic and/or cosmetic agent (i.e.composition 20-A) and a cooling aerosol (i.e. aerosol 47) to provide amore soothing application of laser energy to the skin of a subject.Composition 20-A and aerosol 47 can be applied to skin 8 before, afterand/or simultaneously with the application of laser beam(s) 19 to skin8. The cooled fluid can be water or a saline solution. The cooled gascan be air, nitrogen, or carbon dioxide. The fluid in this embodimentcan be water, saline, lactate solution, or a combination thereof.

FIGS. 4A, 4B, and 4C show embodiments for an attachable tip. Each of thedepicted attachable tips can contain one or more chambers for containingone or more agents in each elongated portion of the attachable tips. Inthe embodiment of the attachable tip of FIG. 4B, one or more laser beams19 pass through a column in the middle elongated portion. In anembodiment of the attachable tip of FIG. 4A, laser beam(s) 19 passthrough a column between a pair of elongated portions. The elongatedportions of the depicted attachable tips can form a standoff forfocusing laser beam(s) 19 onto the skin of a subject with the attachabletips are contacted with the skin of a subject. Thus, the length of theattachable tip can correspond to the focal point of laser beam(s) 19 asproduced by directing lenses. Agents are permitted to escape thechambers from windows 41, 42 and 43. The chambers can contain differentagents which can be applied right before, after and during laser actiondepending on the arrangement of the agents in the chambers and thedirection in which the attachable tip is directed during the applicationof laser beam(s) 19. For example, for the dual standoff attachable tipof FIG. 4A, the chamber with window 42 can contain an anesthetic and thechamber with window 41 can be a therapeutic or skin care agent for skintreatment. Thus, by moving such an attachable tip in a direction withchamber of window 42 leading the movement, an aesthetic can be appliedprior to the application of laser beam(s) 19 and followed by theapplication of a therapeutic or skin care agent from the trailingchamber with window 41. Similarly, the attachable tip of FIG. 4B cancontain three separate agents that are applied before (window 41),during (window 43), and after (window 44) laser action by moving the tipin a direction with the chamber of window 41 leading the motion. Window43 can be on one or both sides of hollow a central column which permitslaser beam(s) 19 to exit the attachable tip. The attachable tips have aportion for connecting to a laser hand piece.

FIG. 5 shows a laser hand piece with a scanner. Laser beam(s) 19 can beconfigured to produce a line of laser damages on a subject's skin. Laserbeam(s) 19 can be produced by a more powerful laser module and used fortreatment of large areas of skin. In order to produce a uniform deliveryof an agent, attachable tip 16 can be replaced with an applicator in theform of a cylindrical roller. Alternatively, attachable tip 16 cancontain a roller ball for applying an agent contained within a chamberin attachable tip 16. To provide an energy source to the laser, are-chargeable battery can be attached to the laser by cable 52. Thebattery can be clipped to the waist belt or be carried in a pocket. Thissystem is also designed to deliver skin surface cooling. In preferredembodiments the surface cooling is provided with a flow of cold air. Thecold air in preferred embodiments is at a temperature of about 0 to 3°C. and may be provided with a commercial, off-the-shelf air-cooling unitor with a simpler unit consisting of a blower unit, an accumulator and atube coiled in an ice water bath.

The attachable tips disclosed herein can be adopted to be attached tothe hand pieces of stationary medical and cosmetic lasers which arecommercially available or already being used in practice. The attachabletips disclosed herein can be used with skin electroporation systems. Insuch case, damage of skin is produced by electrical energy and not lightas in case of a laser.

The attachable tips disclosed herein can be attached to a hand piece bymeans of threads, magnets, interlocking male and female pieces, slidingdovetail configurations, and the like. Each of the attachable tipsdisclosed herein can be combined with hand pieces that deliver: laserenergy; intensive pulse light (IPL) energy; ultrasound energy; radiofrequency (RF) energy; microwave energy; light emitting diode energy;x-rays; ionizing radiation; and electron beams. The hand piece can be anultrasound hand piece. The hand piece can be an electroporation device.The hand piece can be a device for emitting ionizing radiation, such as,for example, a device used in connection with radiation therapy ofcancer. The hand piece can be a laser device, including, but not limitedto a device having a laser selected from the group consisting of:Er:YAG; Er:YSSG; diode laser; solid state laser; excimere laser; CO²laser; CO laser; fiber laser; and a combination thereof.

Laser hand pieces for use with the invention can emit a laser wavelengthranging from 100 to 10,000 nm. The laser wavelength can be, +/−50 nm,190 nm, 530 nm, 640 nm, 800 nm, 1,000 nm, 1,350 nm, 1,550 nm, 1,930 nm,2,700 nm, 3,000 nm, 10,000 nm, or a combination thereof. The laserwavelength can be 190 nm, 530 nm, 640 nm, 800 nm, 1,000 nm, 1,350 nm,1,550 nm, 1,930 nm, 2,700 nm, 3,000 nm, 10,000 nm, or a combinationthereof.

The attachable tips disclosed herein can be used to accomplish thedelivery of one or more therapeutic and/or cosmetic agents. The agentcan be a drug, biologic, or cosmetic agent. The drug can be an antibody,gene, vaccine, antigenic peptide or protein, filling agent (e.g.hyaluronic acid), metal, small molecule, large molecule, or acombination thereof. The agent can be a vasodilator (e.g. minoxidil).The agent can be stem cell factors. The stem cell factors canmesenchymal stem cell factors, including, but not limited to, the stemcell factors disclosed in US Patent Application Publication Nos.2012/0201786 and 2016/0324898, the entire contents of which areincorporated by reference herein in their entirety. The agent can be aPCSK9 inhibitor (e.g. Praluent, Lucentis, Avasitin, or a combinationthereof). The agent can be a protein kinase inhibitor. The agent can bea protein kinase antigen capable of producing antibodies against aprotein kinase. The agent can be a combination of minoxidil, Wntproteins, and one or more stem cell factors. The agent can be acombination of minoxidil, Wnt proteins, and one or more mesenchymal stemcell factors. The agents disclosed herein can be in the form ofmicroparticles, nanoparticles, large particles, liposomes, microsomes,multiphase compositions. The agents can be an exosome. The agents can bean exosome secreted by a mesenchymal stem cell. The agents can be anexosome secreted by a mesenchymal stem cell grown under low oxygenconditions. The agent can be an analgesic, anesthetic,immunosuppressant, antibiotic, lubricant, coolant, dye, opticalenhancer, energy absorber, energy dissipater, or combination thereof.The agent can be insulin or an insulin derivative. The agent can bebotulinum toxin or a derivative thereof.

The agent can be a multiphase composition. Accordingly, the agent can beone or more of a liquid, solid phase (e.g. particle), gas, and gel. Theagent can be a liquid gas and a fluid. The agent can be fluids ofdifferent viscosities. The agent can be a liquid gas and a solid phase.The agent can be a gel and a fluid. The agent can be a mixture ofhydrophobic and hydrophilic liquids in a suspension.

FIG. 6. shows the system in operation with the hand piece being used totreat the face of a patient. In this embodiment a focused laser beamdamages tiny volumes of skin tissue about 0.05×0.1 mm at the surface ofthe skin. Due to compact size of the device the procedure can beperformed by a medical practitioner (e.g. doctor, nurse, etc.) or by thepatient. The laser hand piece can have an internal scanner to providelaser damage at one position of the hand piece, also the beam shapinglenses can be designed in such a way to provide application of pluralityof laser beams.

The above embodiments describe techniques for skin treatments based onthe concept of the combination of a laser delivery system's hand pieceand an agent-containing tip temporarily attached to each other in oneunit. The laser beam produces damage to the skin and the applicatordelivers an agent from the attachable tip to the damage zone. Thatcombination provides a convenient way to deliver medical, cosmeticand/or skin care agents under the surface of the skin and thus improvingthe skin's appearance. It will be appreciated that this concept can beextended to other types of treatments including electrolysis units, forexample.

A hand held laser with scanning system is used for large area skintreatment. For skin rejuvenation purposes attachable tips with vitaminsand antioxidants, botulin toxin and its derivatives in the liquid form,cytokines and cell factors can be used. This combination is for largearea skin rejuvenation including neo-collagen formation, sebaceous glandand bulge area stem cell mobilization can be used with deliverysubstances to regrow hairs.

Laser hand pieced for use with the invention can be single or dualwavelength with or without scanners. Laser hand pieces can be obtainedfrom Dolleris Technology, nLight and Intezity Innovation, Coherent andIPG Photonics. Other laser hand piece suppliers include Palomar(Burlington, Mass.), Cynosure (Westford, Mass.), Candela (Wayland,Mass.), Sciton (Palo Alto, Calif.), Lumenis (Santa Clara, Calif.),Cutera (Brisbane, Calif.), Lutronic (Fremont, Calif.).

The reader should understand that the above specific embodiments of thepresent invention are merely examples and that many changes andmodifications could be made without departing from the importantconcepts of the present invention.

1-42. (canceled)
 43. An attachable tip for an electromagnetic handpiece, comprising: a) a first agent chamber adapted to contain a firstagent, wherein said first agent chamber is in fluid communication with afirst mixing chamber; b) a fluid chamber adapted to receive a coolingfluid, wherein said fluid chamber is in fluid communication with saidfirst mixing chamber and a fluid conduit; c) a second agent chamberadapted to contain a second agent, wherein said second agent chamber isin fluid communication with a second mixing chamber; d) a gas chamberadapted to receive a cooled gas, wherein said gas chamber is in fluidcommunication with said second mixing chamber and a gas conduit; e)wherein said first mixing chamber is adapted to combine said first agentand said cooling fluid to produce a cooled fluid mixture and said secondmixing chamber is adapted to combine said second agent and said cooledgas to produce a cooled aerosol mixture.
 44. The attachable tip of claim43, wherein said first agent chamber comprises a plurality of said firstagent chamber.
 45. The attachable tip of claim 43, wherein said secondagent chamber comprises a plurality of said second agent chamber. 46.The attachable tip of claim 43, wherein said fluid chamber comprises aplurality of said fluid chamber.
 47. The attachable tip of claim 43,wherein said gas chamber comprises a plurality of said gas chamber. 48.The attachable tip of claim 43, wherein at least one of said first agentand said second agent are selected from a therapeutic agent, cosmeticagent, and a combination thereof.
 49. The attachable tip of claim 43,wherein said first agent chamber, said second agent chamber, said fluidchamber, and said gas chamber are concentrically arranged around acentral, hollow column.
 50. The attachable tip of claim 43, wherein saidfirst mixing chamber has a terminal end and said terminal end has atleast one opening to permit said cooled fluid mixture to escape saidfirst mixing chamber.
 51. The attachable tip of claim 43, wherein saidsecond mixing chamber has a terminal end and said terminal end has atleast one opening to permit said cooled aerosol mixture to escape saidsecond mixing chamber.
 52. An electromagnetic energy handpiece fordelivering cooled therapeutic and cosmetic agents, comprising: a) anelectromagnetic handpiece; b) a tip connected to said handpiece, whereinsaid tip comprises: i. a first agent chamber adapted to contain a firstagent, wherein said first agent chamber is in fluid communication with afirst mixing chamber; ii. a fluid chamber adapted to receive a coolingfluid, wherein said fluid chamber is in fluid communication with saidfirst mixing chamber and a fluid conduit; iii. a second agent chamberadapted to contain a second agent, wherein said second agent chamber isin fluid communication with a second mixing chamber; iv. a gas chamberadapted to receive a cooled gas, wherein said gas chamber is in fluidcommunication with said second mixing chamber and a gas conduit; v.wherein said first mixing chamber is adapted to combine said first agentand said cooling fluid to produce a cooled fluid mixture and said secondmixing chamber is adapted to combine said second agent and said cooledgas to produce a cooled aerosol mixture.
 53. The electromagnetic energyhandpiece of claim 52, wherein said first agent chamber comprises aplurality of said first agent chamber.
 54. The electromagnetic energyhandpiece of claim 52, wherein said second agent chamber comprises aplurality of said second agent chamber.
 55. The electromagnetic energyhandpiece of claim 52, wherein said fluid chamber comprises a pluralityof said fluid chamber.
 56. The electromagnetic energy handpiece of claim52, wherein said gas chamber comprises a plurality of said gas chamber.57. The electromagnetic energy handpiece of claim 52, wherein at leastone of said first agent and said second agent are selected from atherapeutic agent, cosmetic agent, and a combination thereof.
 58. Theelectromagnetic energy handpiece of claim 52, wherein said first agentchamber, said second agent chamber, said fluid chamber, and said gaschamber are concentrically arranged around a central, hollow column. 59.The electromagnetic energy handpiece of claim 52, wherein said firstmixing chamber has a terminal end and said terminal end has at least oneopening to permit said cooled fluid mixture to escape said first mixingchamber.
 60. electromagnetic energy handpiece of claim 52, wherein saidsecond mixing chamber has a terminal end and said terminal end has atleast one opening to permit said cooled aerosol mixture to escape saidsecond mixing chamber.